Stop the Scam Campaign Story Collection Form

As part of the Stop the Scam Campaign, the Alliance for Retired Americans is collecting stories to help protect others, improve awareness, and inform policymakers. Sharing your story can make a difference. This form should take no more than 10 minutes to complete. 

Please answer the below questions regarding one fraud/scam experience. Begin a new form to enter an additional fraud/scam story.

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Email *
First name *
Last name *
Phone number
I am entering this information about: *
Fraud/Scam Information
Please provide information about one fraud/scam instance below. 
Type of Fraud/Scam
Clear selection
How were you first contacted?
Clear selection
Date or approximate timeframe of incident
Did you lose money or personal information?
Clear selection
Was the scam reported?
Clear selection
Fraud/Scam Story
Please answer the below questions regarding one fraud/scam experience. Enter details of any additional fraud/scam stories on a separate form.
In your own words, please describe what happened. *

How did this experience affect you (emotionally, financially, and/or personally)? 

What helped you recover or report it (if applicable)? 

What do you wish others knew that could help them avoid a similar scam? 

Demographic Information
Please provide demographic information about yourself. This information will only be used for internal reporting purposes. 
Age range
State/territory
Gender
Clear selection
Union membership (if any)
Privacy Statement

Your privacy matters to us. The information you share through this form will be used to help raise awareness about scams and fraud, advocate for stronger protections, and inform public education and policy efforts.  Your name and/or contact information will only be used to follow up with you about your story or to request permission before using any identifying details publicly. Stories may be shared in reports, outreach materials, or advocacy campaigns, but all personally identifying information will be removed unless you explicitly agree otherwise. Your information will be stored securely and accessible only to authorized members of our campaign team. You may request to have your story or personal data removed or for questions to be answered at any time by contacting Marissa Whitehouse at mwhitehouse@retiredamericans.org.

Do you consent to the collection and use of your information as described above.

A copy of your responses will be emailed to the address you provided.
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